Provider Demographics
NPI:1528297611
Name:BAKER, STACY (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3121
Mailing Address - Country:US
Mailing Address - Phone:803-818-3932
Mailing Address - Fax:844-729-6584
Practice Address - Street 1:735 CHERRY RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3121
Practice Address - Country:US
Practice Address - Phone:803-818-3932
Practice Address - Fax:844-729-6584
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC317749Medicaid
NC5921383Medicaid
NC5921383Medicaid
SCAA87395019Medicare PIN